How Long Can You Stay in Subacute Rehab?
When considering a stay in subacute rehab, one of the most common questions is ‘How long can you stay in subacute rehab?’ Typically, stays can range from a few days to several months, depending on individual needs and medical conditions. This article will explore factors that influence the length of stay, such as medical requirements, rehabilitation goals, and insurance coverage, helping you better understand what to expect.
Key Takeaways
- The duration of stay in subacute rehabilitation varies based on individual needs, typically ranging from 3 to 90 days, with most patients staying around 21 days.
- Medicare provides coverage for subacute rehabilitation under specific conditions, including a 3-day hospital stay rule, with Part A covering medically necessary care for up to 100 days per benefit period.
- Out-of-pocket costs for prolonged stays in subacute rehab can be significant, with specific deductibles and daily rates applied under Original Medicare, while certain services like private duty nursing are not covered.
Duration of Stay in Subacute Rehab
The length of stay in subacute rehabilitation can vary significantly, ranging from as short as three days to as long as ninety days, depending on individual medical and rehabilitation needs. Most patients typically stay in a subacute rehabilitation facility for around 21 days, during which they receive therapy specific to their conditions and objectives. Factors like the patient’s diagnosis, ability to tolerate therapy, and overall medical stability play critical roles in determining the duration of their stay.
Patients typically receive therapy services for 30 minutes to three hours per day, five to seven days a week. Once they have regained sufficient skills to live independently, they can be discharged. For patients recuperating from chronic diseases or serious accidents, a prolonged stay may be required for comprehensive recovery.
Medicare Coverage for Subacute Rehabilitation
Medicare provides substantial support for those needing subacute rehabilitation. Under Medicare Part A, inpatient rehabilitation in skilled nursing facilities is covered for up to 100 days, provided certain conditions are met. This includes coverage for medically necessary care such as:
- rehab services
- semi-private rooms
- meals
- nursing services
- medications
- other hospital services and supplies received during the stay
Importantly, Medicare does not differentiate between subacute and skilled nursing facilities in terms of payment systems; the same rules apply to both.
To be eligible for Medicare coverage of inpatient rehab, your hospital stay must comply with the 3-day rule. This rule requires that you are admitted to the hospital as an inpatient for at least three consecutive days. Comprehending these prerequisites can assist you in obtaining the required coverage for your rehabilitation.
Benefit Periods and Coverage Limits
A benefit period starts on the first day of your hospital stay and includes any inpatient rehabilitation care within the same period. This means that if you are transferred directly from an acute care hospital to an inpatient rehabilitation facility, or if you are admitted to rehab within 60 days after being discharged from the hospital, you will not need to pay a new deductible.
If you are admitted to inpatient rehab within 60 days of a prior hospitalization, the same benefit period continues, helping you avoid additional costs. This continuity can significantly ease the financial burden on patients and their families during what is often a stressful time.
Insurance and Out-of-Pocket Costs
Rehab insurance and Medicare usually serve as the primary financial resources for subacute rehab expenses. Nevertheless, it’s crucial to consider possible personal expenses. Under Original Medicare, the deductible for days 1-60 in an inpatient rehabilitation facility is $1,632. For days 61-90, the out-of-pocket cost rises to $408 per day. Beyond day 90, the cost is $816 per day, utilizing lifetime reserve days.
It’s important to note that Medicare does not cover:
- Private duty nursing
- Private rooms unless medically necessary
- Personal items
- In-room phones and televisions if separately charged
After exhausting all lifetime reserve days, all subsequent costs are out-of-pocket. Familiarity with these potential costs can assist you in planning and budgeting for your stay in rehabilitation.
Criteria for Extended Stays
Medicare provides coverage for prolonged stays in inpatient rehabilitation, given specific conditions are satisfied. Specifically, a doctor must certify that the patient requires intensive rehabilitation, continued medical supervision, and coordinated care. There must also be a reasonable expectation that the patient will benefit significantly from the intensive rehabilitation program.
In addition, the patient must be able to tolerate a minimum of three hours of therapy per day, at least five days a week. Fulfilling these criteria guarantees patients access to the required level of care for their recovery and the restoration of their independence.
Preparing for Your Subacute Rehab Stay
Preparation for a subacute rehab stay should include thoughtful packing to maximize comfort and convenience. Footwear with non-slip soles is essential to prevent falls. Personal care items and toiletries, such as a toothbrush, toothpaste, shampoo, and a blow-dryer, should also be packed, just as you would for a vacation.
Comfortable pajamas that are easy to change and appropriate for the season are ideal for a rehab stay. Additionally, loose-fitting, comfortable daytime and exercise clothing that zips up can make dressing easier. To make your stay more enjoyable, consider bringing items for entertainment, such as books, crossword puzzles, and a cell phone charger.
It’s advisable not to bring expensive jewelry, large sums of money, or mobility aids like canes or walkers unless instructed by the rehab staff. Favorite family photos and scrapbooks can help make the rehab room feel warmer and more personal, while a favorite pillow and blanket can add extra comfort.
